The power of bystander CPR helped to save one little girl's life

Sofia with nurse Shara Griffis, who cared for her on Life Flight en route to the hospital

By Joan Semeria

Sofia Montoya’s life was saved when school staff and community first responders administered CPR after she collapsed on her elementary school playground near Half Moon Bay

Sofia, now home after receiving a pacemaker at Lucile Packard Children’s Hospital Stanford, is expected to make a full recovery

“I did something amazing yesterday!” exclaimed 8-year-old Sofia Montoya. “I climbed to the top of the play structure all by myself!”

This would be a normal occurrence for most third graders, but it’s not something Sofia’s parents or her doctors at Lucile Packard Children’s Hospital Stanford expected so soon after Sofia went into sudden cardiac arrest while playing with friends.

On April 18, while playing tag at her elementary school near Half Moon Bay, Sofia slumped to the ground and was unresponsive. Sofia’s friends ran for help. A staff member, who found that Sofia had no pulse and wasn’t breathing, performed CPR as a 911 dispatcher walked her through the steps. Hearing the call over the radio, a sheriff in the area quickly arrived and took over CPR until the Moss Beach Fire Department got to the school. Firefighters continued CPR and used a defibrillator twice to get Sofia’s heart to start beating again.

It was quickly determined that Sofia needed to be treated at a trauma center, so she was transported by ambulance to the Half Moon Bay airport, where Stanford’s Life Flight helicopter was waiting.

“When I first saw her, she was lying on a backboard with a collar on. She was white as a sheet, not moving or breathing very well,” said Shara Griffis, RN, the flight nurse who was on board with Sofia.

During the 10-minute flight to the hospital, Sofia again stopped breathing. Griffis inserted a breathing tube in her mouth. Griffis knew that Sofia’s brain was in danger of not getting sufficient oxygen — a primary concern when someone has to be resuscitated.

At Packard Children’s, Sofia went through a series of diagnostic tests to determine why she had gone into cardiac arrest. The hospital’s Children’s Heart Center team diagnosed Sofia with long QT syndrome, a disorder of the heart’s electrical system that causes fast, chaotic heartbeats resulting in fainting spells, seizures or, in some cases, sudden death. Long QT syndrome can be caused by a genetic mutation and is often inherited. Sofia’s family members have all gone through genetic testing to see if they carry the same mutation.

Once Sofia was stabilized, pediatric cardiologist Scott Ceresnak, MD, surgically placed an implantable cardioverter defibrillator (ICD) in Sofia’s chest to help regulate her heartbeat. If the device detects an irregular heartbeat, it generates an electrical shock to restore a normal heart rate and rhythm.

After 11 days in the hospital, Sofia returned home. She has resumed most of her normal activities and is expected to make a full recovery.

“The long-term outlook for Sofia is excellent,” said Ceresnak, an assistant professor of pediatric cardiology at the Stanford University School of Medicine. “With the combination of beta blocker medicines, which reduce cardiac events, and the ICD, we expect Sofia to live a long, healthy, fruitful life. And thanks to the tremendous CPR she received, she has made incredible neurological recovery.”

Life-saving CPR

While the ICD will keep Sofia’s heart from malfunctioning, it’s the CPR and early defibrillation that saved her life and improved her outcome.

“Sofia’s story is a perfect example of all the pieces coming together,” said Lynda Knight, MSN, RN, director of the REVIVE Initiative for Resuscitation Excellence at Stanford Children’s Health. “This scenario is what we train for, starting with bystander CPR. Evidence shows that if a bystander performs CPR, the outcome will be better. Paramedics take, on average, four to eight minutes to arrive, and each minute that someone goes without chest compressions, their chance of survival goes down by 10 percent.”

In 2013, Knight led an observational study that demonstrated the effectiveness of sending parents of children who have cardiac problems home with a video-based, self-instructional CPR kit called CPR Anytime. Parents reported that they felt empowered by their knowledge of CPR, and most shared the kit with at least two other family members or friends. Since the program began, 10 families who received the kit have performed CPR on their child. Nine of those children survived with favorable neurological outcomes. To date, more than 6,500 families have received the free CPR kits, with an estimated impact of 19,000 community members becoming trained in CPR.

Understanding the difference between treating cardiopulmonary events in children and adults is especially critical for first responders. That’s why Knight developed the Pediatric Advanced Workshop with Simulation program to train firefighters in pediatric CPR by using scenarios based on real cases of critically ill and injured children. The REVIVE American Heart Association Training Center, located at Packard Children’s, also trains an additional 1,500 local health care professionals annually in Pediatric Advanced Life Support.

Shawna Montoya, Sofia’s mother, acknowledges that her daughter wouldn’t be here today or in her current state of health if she had not received quality CPR.

“Although Sofia has some memory loss, she is making amazing strides every single day,” said Montoya. “I’m so thankful for everyone who was part of her recovery and for the support of our community. My mission now is to promote CPR training because obviously it can save a life. My daughter is living proof of that.”